SAMMANFATTNING Syfte  Syftet med uppsatsen är att undersöka om Sveriges ungdomsmottagningar har liknande förutsättningar att arbeta på ett kvalitetssäkert sätt utifrån de styrdokument som ett urval av mottagningar använder. Ungdomsmottagningar drivs utan nationellt uppdrag och av olika uppdragsgivare och utan enhetliga uppdragsbeskrivningar. Detta skulle kunna vara orsaken till de stora skillnader i bland annat kompetens, struktur och tillgänglighet som rapporter pekar på. Detta skulle kunna leda till bristande eller varierande vårdkvalitet. Metod Genom en kvalitativ innehållsanalytisk ansats undersöks om ett strategiskt urval av styrdokument från ungdomsmottagningsverksamheten behandlar de kvalitetsområden som framgår i Socialstyrelsens föreskrift om ”God Vård”. Reslutat De styrdokument som undersökts ger ett samlat intryck av vad en ungdomsmottagning arbetar med. De har alla ett övergripande mål med i stort sett samma betydelse; att främja ungdomars fysiska och psykiska hälsa, stärka deras identitetsutveckling så att de kan hantera sin sexualitet samt att förebygga oönskade graviditeter och sexuellt överförbara infektioner. Detta mål anger ramen för verksamheten. De styrdokument som studerats uppvisar stora skillnader, framför allt i hur utförligt man beskriver sina mål, samt i hur uppföljnings- och kvalitetsförbättringsarbetet beskrivs. De dokument som bäst täcker God vårds kvalitetsmål, är mer generella och lämnar större tolkningsutrymme till bland annat personal och huvudmän. Detta skulle kunna ge stora skillnader i vårdkvalitet, vilket också påvisats i svenska studier och rapporter. Ytterligare forskning om hur personal och huvudmän har uppfattat ungdomsmottagningarnas uppdrag behövs göras för att stärka denna teori. Slutsats Utifrån de undersökta dokumenten kan sägas att alla ungdomsmottagningar inte har fått liknande förutsättningar för att arbeta på ett kvalitetssäkert sätt utifrån vad God Vård anger. De mål som anges i styrdokumenten lämnar oftast för stort tolkningsutrymme. Det gemensamma övergripande målet för ungdomsmottagningarna tycks finnas, men hur man når dit är mer oklart, d.v.s. den gemensamma styrningen saknas. / ABSTRACT Aim The purpose of this paper is to examine whether Swedish “ungdomsmottagningar” (youth center for services and counseling of sexual and reproductive health) have been given similar opportunities to work in a quality safe way from the policy documents that a sample of clinics use. Today all ”ungdomsmottagningar” are providing care without national mandate, by different healthcare providors and without homogenous mission. This could be a reason for the vast differences reported, in for example in competence, structure and access. There is a risk that the result is a lack of quality of care. Method The various policy documents from the youth centers are examined through a qualitative analytical content approach. The quality areas presented in the National Board of Health and Welfare directive on "Good Care" are searched in the documents. Result The policy documents examined give an overall impression of what a youth center is about. They all have one main goal with essentially the same purpose: to strengthen young people's physical and psychological health, strengthen their identity development toward a safe and responsible sexuality. Their mission is also to prevent unwanted pregnancies and sexually transmitted infections. This goal only defines the framework around the “youth centers”. The policy documents studied show major differences, especially in the detailing of described goals as well as in monitoring and improving quality of work. The documents that best matches ”good care” are more general but leave more room for interpretation on numerous factors, including staffing and principals. This could lead to large differences between the youth centers, which also are demonstrated in Swedish studies and reports. Further research on how staff and principals are perceived by the youth centers mission is needed to strengthen this explannation. Conclusion Based on the reviewed documents it can be said that all youth centers have not received similar conditions to work in a quality safe manner from what Good Care indicates. All policy documents indicate, in principle, the same overall objective. The common goal seems to exist but how to reach it, is still uncertain. The common guide is missing.

Abstract Background Working in primary care with chronic leg ulcers is both time-consuming and difficult. There is a large category of patients with leg ulcers, that is expected to increase in a number of years, and many of them will probably come to a district nurse for help. Aim The aim of this study was to describe the district nurses' experiences of caring for patients with chronic leg ulcers in primary care. Method The approach was qualitative. The study was done with a phenomenological life-world approach. Seven district nurses working in primary care were interviewed. The phenomenological perspective focuses on the respondents’ own life-world and has openness to the interviewee's own experiences. The phenomenon we wanted to study was the district nurses’ experiences of caring for patients with chronic leg ulcers. Results In the study it emerges that district nurses feel that it is fun to work with this patient category, although the workload can sometimes feel heavy. There are often many long meetings, for a long period of time, and a relationship evolves between the district nurse and the patient. The nurses feel they have a different and deeper relationship with these patients and they experience the emergence of an unusual friendship.

Objective: To recognize the difference of patient care offered by primary care family physician, internist and generalist, according to the incidence rate of the acute complications, time to event interval of the chronic complications and the cost of OPD, admission and emergency care. Method: The first diagnosed diabetes patients were extracted from the National Health Insurance database, utilizing data from 2001 to 2007 to fit the criteria. Patients with catastrophic illness and who attended to the primary care clinic less than 20% of total OPD visits were excluded. The incidence rate of DM acute complications such as hypoglycemia, NKHS and DKA, and the time to event interval of DM chronic complications such as CAD, stroke, DM nephropathy, DM retinopathy, polyneuropathy and DM peripheral artery disease were investigated. Furthermore, the cost of OPD visit, emergency care and hospital admission was also evaluated. Result: The patients cared by primary care family physician tended to get hypoglycemia more frequently, but less likely to get hyperglycemic complications including both DKA and NKHS.The family physician did not recognize the large vessel complications well but can effectively control the diabetic neuropathy and diabetic nephropathy. Compare to those cared by internist, the patients cared by family physician have the lower expense on diabetic related OPD visit, but a little higher on emergency and admission. Totally, the patients cared by family physician have the lowest cost compared to internist and generalist, but without significant difference. Conclusion: The cost of OPD visit was significantly lower in patient cared by primary care family physician compared to internist without sacrifice the quality of care. Further study was necessary due to the limitation of the application of secondary database.

Primary care physicians are the first point of contact for patients entering the formal health care system. A shortage of primary care physicians in the United States has left approximately 60 million people without adequate access to a physician, resulting in lowered health care outcomes and excess stress on the health care safety net. Texas has one of the most severe shortages of primary care physicians with more than 5.7 million people living in rural and urban areas considered to be underserved. The state’s rapid population growth, as well as the wide geographic distribution of its residents, makes it particularly vulnerable to health care disparities. Although there is a decisive need, factors like high medical school debt and low anticipated salaries are leading more students to specialize instead of pursue a primary care career. A variety of solutions have been proposed to address this problem including: rethinking the physician reimbursement structure; expanding graduate medical education opportunities for primary care students; and incentivizing primary care with loan repayment. In 2014, the new insurance exchanges created by the Patient Protection and Affordable Care Act will begin operating, giving millions more Texans access to health insurance. The current Texas primary care physician workforce shortage will be exacerbated once the major components of the Patient Protection and Affordable Care Act are fully enacted; therefore, state policymakers must take steps to increase Texas’ primary care physician workforce by making primary care a more attractive and accessible career path for medical students. / text

Colorectal cancer (CRC) is a leading cause of cancer-related deaths around the world. The identification and description of many modifiable and non-modifiable risk factors to CRC has spurred the development of prevention and early detection protocols and recommendations to help reduce CRC incidence and mortality. Measures to manage CRC include diagnostic screenings and lifestyle changes. As rates of screening increase, prevention counseling rates among primary care providers (PCPs) remain low. Barriers to nutrition prevention reported by PCPs are inconsistent across the literature which has led to confusion about the reason for poor nutrition prevention efforts among PCPs. This practice inquiry (PI) addressed the identified practice gap using the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. In the "Plan" phase (Chapter 2), a systematic review of the research literature determined existing nutrition recommendations for CRCs and barriers to implementation by PCPs. Development of several nutrition recommendations for fiber, vitamin D, alcohol, red and processed meats intakes, and dietary patterns were outlined for PCP use in practice. Barriers to nutrition prevention implementation were identified as time, reimbursement, knowledge, and health literacy. To augment findings from the literature, a provider survey was completed (Chapters 3-4). Barriers identified by the participants (n=47) include lack of time, education materials, nutrition knowledge, low health literacy, and lack of patient interest. These findings indicate that several changes are needed to improve the use of CRC prevention guidelines, including additional education and education materials, changes in office policy and additional research to create and analyze the interventions recommended to improve existing nutrition prevention counseling for CRC.

Purpose: To identify barriers to implementing practice recommendations regarding HPV (human papillomavirus) vaccination for male adolescent patients among Family Nurse Practitioners (FNPs). Rationale/Background: HPV infection is a source of numerous cancers. More than one-quarter of the HPV-associated cancers in the United States occur in males. The quadrivalent vaccine is approved in young males and is effective in the prevention of genital warts and reducing HPV related cancers yet vaccination rates are low and expected to remain low. Barriers to vaccination exist even after the 2011 recommendation for routine use. Method: Quantitative, surveys. A 22-item instrument was administered to FNPs working in primary care settings. Participants were surveyed regarding financial, logistic, provider, and parental barriers to vaccination among adolescent males. Results: Descriptive analysis at both the item and scale level demonstrated that FNPs report financial barriers as the most significant barrier. The barriers of least concern were provider attitudes. Barriers regarding FNPs' perception of parental attitudes were seen as moderately concerning. Independent samples t-tests showed that FNPs who did not administer the HPV vaccine to male adolescent patients reported having significantly more financing barriers as compared to FNPs who did. Conclusion: Results suggested that financial issues may constrain FNPs' implementation of practice recommendations for the HPV vaccine and that FNPs who did not administer the HPV vaccination to adolescent male patients may be unable to do so due to financial reasons. Perceptions of parental attitudes are also seen as playing a role in preventing male adolescent patients from receiving the HPV vaccine. Efforts to reduce barriers to implementing recommended HPV vaccine practices should focus on lessening the expense of the vaccine for both providers and parents and increasing parental knowledge and understanding of the HPV vaccine for their sons. Definitions: HPV4 is used to reference the quadrivalent and Gardasil® vaccinations; permissive refers to the 2009 Advisory Committee on Immunization Practices (ACIP) support of allowing adolescent males aged 9-26 to decide, in collaboration with their health care providers, to vaccinate; recommended is the ACIP's modification from permissive to routine recommendation.

Aim of the study. To evaluate the satisfaction of the patients with the primary odontology care and the factors influencing it in public institution Šeškinės Poliklinika. Methods. In January – April, 2005 an anonymous questionnaire survey of the patients (n=448) from odontology department of Vilnius city public institution Šeškinės Poliklinika, where odontology services of primary level are provided, was carried out. The response rate was 89,6 percent. The data was analyzed using statistical data analysis package SPSS 9.0. Results. 71 percent of the patients from Vilnius city public institution Šeškinės Poliklinika were completely satisfied with the services. 24 percent were satisfied, 5 percent were not satisfied, there were no patients who were completely not satisfied. 90 percent of the patients would like to be treated in the same department in the future. About 90 percent of the patients were completely satisfied with the communication with the doctor and his competence. The satisfaction of the patients was related to the following factors: family status (there were less satisfied patients among single and widows than in other family status groups); education (there was the least number of satisfied patients among the respondents who had elementary and unfinished secondary education); social – professional status (there was the least number satisfied patients among the unemployed); certain service accessibility factors (there were more satisfied patients among those... [to full text]

Aim of study to evaluate the epidemiological situation of overweight among Lithuanian adult population and its control possibilities in primary health care. Objectives- to evaluate the prevalence of overweight and obesity among Lithuanian population aged 20-64 years and its trends over 1994-2004, to determine the associations between overweight and social factors such as sex, age, the level of education and the place of residence and healt behaviuor,to determine the links between overweight and subjective health, to assess the level of giving advice on diet and physical activity by health care specialists and attempts of overweight persons to control their weight,to evaluate the possibilities of weight control in primary health care applying minimal intervention.

In primary care (PC) health providers are delivering nutrition advice and counselling to patients. Yet, a number of challenges have been identified in conducting dietary assessment (DA). Electronic DA (e-DA) tools within mobile apps or websites can potentially facilitate DA in team-based PC. The objective of the study was to explore current DA practices and use of e-DA tools by various disciplines of health providers in Family Health Teams (FHTs) using a mixed-methods sequential design. Data collection included interdisciplinary focus groups (FGs) and a web-based survey. Fifty health providers from various disciplines participated in 11 FGs. Identified themes included: 1) Assessment of diet in an interdisciplinary fashion; 2) Improvement of patients’ eating habits with use of e-DA tools; 3) Support of health providers with use of e-DA tools; and, 4) Integration of e-DA tools into FHTs. One hundred and ninety-one health providers from 89 FHTs were included in the web-based survey. The two studies found that most providers offer a DA very frequently with diverse DA methods. The use of e-DA tools by health providers and patients is still low, although registered dietitians significantly use more e-DA tools than other health providers. There was high interest among all disciplines in the use of e-DA tools for the management of obesity, diabetes and heart disease, especially for patient self-monitoring. Several recommendations were suggested to facilitate uptake of e-DA tools into practice. / Ministry of Health and Long-Term Care (MOHLTC). Primary Health Care Transition Fund.

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